Patient Story - Cardiac Surgery

Smooth sailing ahead? Not exactly

As Antoine Dalnoky checked off the final preparations for an extended sailing trip with his family, heart surgery wasn't on his list. He was in Charleston, South Carolina, making certain his sailboat was in top condition before embarking on a several-months-long journey through the Panama Canal, then up the Pacific coast to his home in the San Juan Islands. Exactly one week before their planned departure, Antoine awoke in the night with an unusually strong and irregular heartbeat. He checked into the emergency room the following day, where the doctor sent him to a cardiologist.

A history of a heart murmur

Heart problems weren't anything new to Antoine. In 1984, at age 34, he was diagnosed with mitral valve regurgitation — commonly known as a heart murmur. His condition wasn't serious, so Antoine was told to check in with a doctor every year to make certain it wasn't becoming worse. And for 20 years or so, he checked out just fine — but this time, Antoine needed more serious attention.

The heart's mitral valve lies between the left ventricle and the left atrium, or the upper and lower chambers. A one-way gate of sorts, it opens to allow blood returning from the lungs into the left ventricle, then closes to keep blood from returning to the heart's upper chamber. Antoine's valve was actually torn, so it was unable to close properly; the result was an increasing amount of blood leaking back into his heart. The cardiologist in Charleston urged him to postpone his sailing trip, return to his home and seek care to repair his leaky valve.

Good advice from a friend — and from a doctor

Although Antoine felt fine, he certainly did not want to put his health at risk. So he returned to the Northwest, where a good friend recommended that he see Dr. Sarah Speck, a cardiologist at Swedish. He went to see her at the first opportunity, armed with all his test results from Charleston. She conducted further tests, confirmed the diagnosis of severe mitral regurgitation due to the torn valve, and uttered the three words Antoine did not want to hear: “You need surgery.”

A long road to recovery — or a short one

The prospect of heart surgery strikes fear into most everyone. First, the patient's heart is stopped during the operation, which typically takes several hours. What's more, with traditional open-chest surgery, the breastbone is split through a foot-long incision to allow access to the heart. Finally, when the surgery is complete, a 12-inch scar remains a permanent reminder that the heart has been repaired.

To Antoine, something else was even more frightening — the prospect of a long, tedious recovery. “I was not afraid of the surgery,” he says, “but I heard the recuperation can be long due to the fact they open your ribcage and sternum. So I was ready to spend years getting back in good shape, being able to do what I want.” For someone as physically active as Antoine, that possibility was not appealing.

A much more patient-friendly approach

Dr. Speck suggested to Antoine that Swedish might be able to offer a procedure less intrusive than the traditional open-chest surgery. She then walked with him over to the office of Dr. Glenn Barnhart, medical director of Cardiac Surgery at the Swedish Heart & Vascular Institute. After meeting with Antoine, studying his case and conducting a final test, Dr. Barnhart shared very welcome news: Antoine was an ideal candidate for minimally invasive surgery to repair his mitral valve. “That was music to my ears,” recalls Antoine, “because that was exactly what I wanted.”

A classic win-win

When Dr. Barnhart explained the benefits of minimally invasive surgery, his new patient immediately became more enthusiastic about the operation. Rather than the foot-long incision required with traditional heart surgery, Antoine will need only two small incisions. The first is two or three inches long, between the ribs on the right side of his chest. Dr. Barnhart guides his instruments though a small tube here, and because he can work through the ribs, no cuts to any bones are necessary. The second incision is in Antoine's left groin, to provide access for connections to the heart-lung machine.

“Recovery is much quicker with minimally invasive surgical patients,” explains Dr. Barnhart. “They don't have a significant wound burden like they do with an open-chest procedure, so they're able to breathe easier and take deep, full breaths much more quickly. They feel better and become mobile much sooner. The need for blood transfusions is less. And for cosmetic reasons, there are certainly advantages to having smaller incisions.”

Dr. Barnhart sees the big picture — literally

The advantages of minimally invasive mitral valve surgery are readily apparent to patients. But one key benefit is invisible to them — and ten times more visible to Dr. Barnhart. Once the patient is successfully attached to the heart-lung machine and the heart has stopped, the surgeon inserts a miniature camera through a tiny incision in the chest wall and advances the camera into the patient's heart. The mitral valve is then projected onto a 22-inch computer monitor, which Dr. Barnhart studies as he repairs the valve.

“Exposure is critical,” explains Dr. Barnhart. “As a surgeon, I must be able to see the field I'm working on. The mitral valve is actually buried within the heart; it's not sitting up for the surgeon to see. And the normal human mitral valve is quite small — between an inch and a half and two inches across. On the screen, it's ten times its actual size — a dramatic difference for a heart surgeon.”

Successful surgery for Antoine

Antoine scheduled the surgery to repair his torn mitral valve, and all went even better than he expected. The surgery took about five hours and was completed by Dr. Barnhart and his team, which includes cardiac anesthesiologists, a specially trained nursing staff and experts in the use of the heart-lung machine.

A quick — and happy — departure

Antoine underwent surgery on Wednesday, was walking on Thursday and checked out of the hospital on Saturday at noon. “A week to ten days after that,” recalls Antoine, “I started to feel better than before I came in for surgery.” Six weeks after returning home, Antoine was practicing football drills with his son. A friend, watching from the sidelines, concluded that Antoine couldn't possibly have had heart surgery just a month and a half earlier. “I had to show him my scar,” laughs Antoine.

A bon voyage

Antoine Dalnoky couldn't be happier with the care he received from Dr. Barnhart and his entire team at Swedish Heart & Vascular Institute. If you'd like to ask him yourself, however, you'll have to wait a bit. He's off sailing.

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